Care at the End of Life

The Dying Process

If you are dying or are caring for a dying loved one, you may have questions and concerns about what will happen physically and emotionally as death approaches. The following information may help answer some of these questions.

Signs of approaching death

The dying process is as variable as the birthing process. The exact time of death cannot be predicted, nor can the exact manner in which a person will die. But people in advanced stages of a terminal illness experience many similar symptoms as they approach the end of life, regardless of their illness.

Several physical and emotional changes occur as death approaches, including:

• Excessive sleepiness and weakness as periods of wakefulness become shorter and overall energy declines.
• Breathing changes, such as periods of rapid breathing alternating with short episodes when breathing stops.
• Visual and hearing changes, such as seeing people or scenes that others do not (hallucinations).
• Decreased appetite as your metabolism slows and you no longer have the same interest in food.
• Urinary and bowel changes, such as dark or red urine and hard stools that are difficult to pass (constipation).
• Temperature changes, such as running a high temperature or feeling very cold.
• Emotional changes, such as becoming less interested in the outside world and being less socially involved with others.

Dying people may also experience symptoms specific to their illness. Talk to your doctor about what to expect. Also, if you have chosen to receive hospice care, the hospice team is available to answer any questions you may have about the dying process. The more you and your loved ones know, the better prepared you will be to cope with what is happening.

Pain

Palliative care can help you to feel relief from physical symptoms related to your illness, such as nausea or difficulty breathing. Pain control and symptom control are important parts of managing your illness and improving the quality of your life.

Whether a person suffers from physical pain in the days before death often depends on the illness. Some terminal illnesses, such as bone or pancreatic cancer, are more likely to be accompanied by physical pain than others.

Pain and other symptoms can be so feared that a person considers physician-assisted death. But pain associated with the dying process can be managed effectively. Any pain should be reported to your family and your doctor. Many medicines and alternative methods (such as massage) are available to treat the pain associated with dying. Do not hesitate to ask for help. Have a loved one report your pain if your illness prevents you from communicating with your doctor.

You may want to protect your family from your suffering. But it is important to tell them if your pain level is not tolerable so they can tell your doctor right away.

Spirituality

Spirituality refers to a person's sense of meaning and purpose in life. It also refers to a person's relationship to a higher power or an energy that gives life meaning.

Some people do not think of spiritual matters often. For others, spirituality is a part of daily life. Facing the end of your life may cause you to confront your own spiritual questions and issues. Organized religion provides comfort to many people as they face death. Others may find solace in exploring nature, through community involvement, by strengthening existing relationships, or by developing new relationships. Think about what provides comfort and support to you. What questions and concerns do you have? Don't hesitate to ask for support from friends, family, hospice, or spiritual advisors.

Caring for a dying loved one

The dying process can be a time for growth. It offers the dying person and his or her family and friends a time to mend relationships, share memories, and say their good-byes. If you are a caregiver, it is important to communicate openly with your dying loved one. Also, seek support from others and take care of yourself so you don't become physically and mentally exhausted.